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仅做 整合 / 美化 处理
A few years ago, I broke into my own house.
几年前，我闯入了自己的家。
I had just driven home,
我开车回到家，
it was around midnight in the dead of Montreal winter,
在蒙特利尔的寒冬， 大约午夜时分，
I had been visiting my friend, Jeff, across town,
我开车从城镇一边到另一边， 去看望我的朋友Jeff,
and the thermometer on the front porch read minus 40 degrees --
门廊上的温度计显示零下40度——
and don't bother asking if that's Celsius or Fahrenheit,
不需要知道是摄氏度还是华氏度,
minus 40 is where the two scales meet --
到了零下40度， 两个温度显示都一样——
it was very cold.
天气非常冷。
And as I stood on the front porch fumbling in my pockets,
当我站在门廊，摸索着我的口袋，
I found I didn't have my keys.
发现找不到钥匙。
In fact, I could see them through the window,
实际上，我透过窗户能看到我的钥匙，
lying on the dining room table where I had left them.
我把它们留在了餐桌上。
So I quickly ran around and tried all the other doors and windows,
我赶紧围着房子转， 找能进去的门和窗户，
and they were locked tight.
而它们都被锁紧了。
I thought about calling a locksmith -- at least I had my cellphone,
我想到打电话给锁匠， 至少我还有手机，
but at midnight, it could take a while for a locksmith to show up,
但在午夜， 锁匠要过来可能需要一段时间，
and it was cold.
并且天气真的很冷。
I couldn't go back to my friend Jeff's house for the night
当晚我又不能回朋友Jeff的家，
because I had an early flight to Europe the next morning,
因为第二天我要坐早班机到欧洲，
and I needed to get my passport and my suitcase.
必须要进屋里拿护照和行李。
So, desperate and freezing cold,
因此，在绝望和寒冷中，
I found a large rock and I broke through the basement window,
我找到一块大石头， 打破了地下室的窗户，
cleared out the shards of glass,
清理了玻璃碎片后，
I crawled through,
我爬进屋里，
I found a piece of cardboard and taped it up over the opening,
找到了一块硬纸板，用胶带 把它封贴在打破的窗户上，
figuring that in the morning, on the way to the airport,
我想着早晨去机场的路上，
I could call my contractor and ask him to fix it.
可以打电话给承包商， 请他来修理窗户。
This was going to be expensive,
修理费会很昂贵，
but probably no more expensive than a middle-of-the-night locksmith,
但不会比在午夜时 找锁匠来开锁更贵，
so I figured, under the circumstances, I was coming out even.
所以我觉得，在这种情况下 即使打破了窗户，也还划得来。
Now, I'm a neuroscientist by training
我是一个职业的神经科学家，
and I know a little bit about how the brain performs under stress.
我大概知道在压力下 大脑是如何工作的。
It releases cortisol that raises your heart rate,
大脑会释放皮质醇引起你的心率加速，
it modulates adrenaline levels
它调节你的肾上腺素水平
and it clouds your thinking.
并阻碍你的思维能力。
So the next morning,
第二天早晨，
when I woke up on too little sleep,
我醒来的时候严重睡眠不足，
worrying about the hole in the window,
还在担心窗户上打破的洞，
and a mental note that I had to call my contractor,
心里想着必须打电话给承包商，
and the freezing temperatures,
还有，天气非常寒冷，
and the meetings I had upcoming in Europe,
在欧洲有个会要开，
and, you know, with all the cortisol in my brain,
还有，因为我大脑释放的皮质醇，
my thinking was cloudy,
我的思维变得混沌，
but I didn't know it was cloudy because my thinking was cloudy.
但我没觉察到它很混沌， 因为我的思维很混沌。
(Laughter)
（笑声）
And it wasn't until I got to the airport check-in counter,
直到我在登机手续办理柜台时，
that I realized I didn't have my passport.
才意识到我忘了带护照。
(Laughter)
（笑声）
So I raced home in the snow and ice, 40 minutes,
于是，我在冰天雪地中 用了40分钟赶回家，
got my passport, raced back to the airport,
拿了护照后，又赶回机场，
I made it just in time,
刚好赶上了飞机，
but they had given away my seat to someone else,
但他们已把我的座位给了别人，
so I got stuck in the back of the plane, next to the bathrooms,
我不得不坐在飞机最后一排， 紧挨着洗手间，
in a seat that wouldn't recline, on an eight-hour flight.
在八个小时的飞行中， 我的座椅都不能往后倾。
Well, I had a lot of time to think during those eight hours and no sleep.
于是我就有了很多时间去思考， 因为我在八小时中无法睡觉。
(Laughter)
（笑声）
And I started wondering, are there things that I can do,
我开始想，我能做些什么，
systems that I can put into place,
有什么切实可行的方法，
that will prevent bad things from happening?
可以防止不好的事发生呢？
Or at least if bad things happen,
或者至少， 就算不好的事情真的会发生，
will minimize the likelihood of it being a total catastrophe.
也能把损失降到最小。
So I started thinking about that,
所以，我开始思考这个问题，
but my thoughts didn't crystallize until about a month later.
但我没有想出来， 直到一个月后，
I was having dinner with my colleague, Danny Kahneman, the Nobel Prize winner,
我和同事，也是诺贝尔奖获得者 Danny Kahneman去吃晚餐，
and I somewhat embarrassedly told him about having broken my window,
我有点尴尬地告诉他， 我打破窗户爬进屋里，
and, you know, forgotten my passport,
还有忘记拿护照的事，
and Danny shared with me
而Danny和我分享了
that he'd been practicing something called prospective hindsight.
他一直在练习的 称为”预测后见之明“的东西。
(Laughter)
（笑声）
It's something that he had gotten from the psychologist Gary Klein,
这是他从心理学家Gary Klein 那里学到的。
who had written about it a few years before,
Gary 前几年已经写了这个理论，
also called the pre-mortem.
也称为"事前剖析"。
Now, you all know what the postmortem is.
你们都知道事后剖析是什么意思。
Whenever there's a disaster,
每当有灾难，
a team of experts come in and they try to figure out what went wrong, right?
一个专家小组就会前去调查， 尝试找出导致灾难的原因，对吧 ？
Well, in the pre-mortem, Danny explained,
而Danny解释，在事前剖析中，
you look ahead and you try to figure out all the things that could go wrong,
你要预测， 尝试想出可能出错的所有事情，
and then you try to figure out what you can do
然后你要尝试可能的方法来
to prevent those things from happening, or to minimize the damage.
防止这些错误发生， 或将损失降到最小。
So what I want to talk to you about today
所以，今天我想和你们谈谈关于
are some of the things we can do in the form of a pre-mortem.
在事前剖析中， 我们能做的一些事情。
Some of them are obvious, some of them are not so obvious.
有些方式是显而易见的， 而有些则不那么明显。
I'll start with the obvious ones.
我先谈显而易见的方式。
Around the home, designate a place for things that are easily lost.
在家里，指定一个地方， 放容易丢失的东西。
Now, this sounds like common sense, and it is,
这听起来就像是常识，也的确是，
but there's a lot of science to back this up,
但这符合我们空间记忆的工作原理，
based on the way our spatial memory works.
有很多科学依据支持这一点。
There's a structure in the brain called the hippocampus,
在我们大脑里， 有一个叫海马体的结构，
that evolved over tens of thousands of years,
已经进化超过数万年了，
to keep track of the locations of important things --
它可以追踪重要东西的位置——
where the well is, where fish can be found,
例如，水井的位置， 能够发现鱼的地方，
that stand of fruit trees,
果树的位置，
where the friendly and enemy tribes live.
以及友好物种和敌对物种 分别居住在哪里。
The hippocampus is the part of the brain
海马体是大脑的一部分，
that in London taxicab drivers becomes enlarged.
伦敦出租车司机的 海马体结构通常比常人要大。
It's the part of the brain that allows squirrels to find their nuts.
松鼠能找到坚果， 也要归功于它们大脑的海马体。
And if you're wondering, somebody actually did the experiment
你们可能对这点感到疑惑， 但有人的确做了一个实验。
where they cut off the olfactory sense of the squirrels,
他们切掉了松鼠的嗅觉器官，
and they could still find their nuts.
松鼠仍然能找到它们的坚果。
They weren't using smell, they were using the hippocampus,
它们不是用嗅觉， 而是用大脑的海马体，
this exquisitely evolved mechanism in the brain for finding things.
这个进化完美的大脑机制 是用来找东西的。
But it's really good for things that don't move around much,
但只是对找固定的东西比较有效，
not so good for things that move around.
找会移动的东西却不是很管用。
So this is why we lose car keys and reading glasses and passports.
这就是为什么我们会常常找不到 车钥匙，老花镜和护照。
So in the home, designate a spot for your keys --
所以，在家里指定一个 地点存放你的钥匙——
a hook by the door, maybe a decorative bowl.
门上的挂钩，或是一个装饰碗。
For your passport, a particular drawer.
在一个特定的抽屉存放你的护照。
For your reading glasses, a particular table.
你的老花镜要放在特定的桌子上。
If you designate a spot and you're scrupulous about it,
如果你指定了特定的地方， 并且一丝不苟地做这些事，
your things will always be there when you look for them.
当你寻找它们时， 这些东西总是会在那里。
What about travel?
关于旅行呢？
Take a cell phone picture of your credit cards,
用手机拍下你信用卡的照片，
your driver's license, your passport,
还有你的驾照和护照，
mail it to yourself so it's in the cloud.
把这些照片发到你的电子邮箱， 储存在数据云端。
If these things are lost or stolen, you can facilitate replacement.
如果一旦丢失或被盗了， 你可以很方便地用电子件代替它们。
Now these are some rather obvious things.
这些是一些显而易见的 事前剖析方法。
Remember, when you're under stress, the brain releases cortisol.
记住，当你有压力时， 大脑会释放皮质醇。
Cortisol is toxic, and it causes cloudy thinking.
皮质醇是有毒的， 它会导致思维不清晰。
So part of the practice of the pre-mortem
所以，做事前剖析的练习，
is to recognize that under stress you're not going to be at your best,
是要认识到在压力下， 你不是在最佳状态，
and you should put systems in place.
你还应该把事情做到井然有序。
And there's perhaps no more stressful a situation
不过也许没有什么 比你要做医疗决策
than when you're confronted with a medical decision to make.
更紧张的情况了。
And at some point, all of us are going to be in that position,
有时，我们都会经历这种事情，
where we have to make a very important decision
我们必须要做出一个很重要的决策，
about the future of our medical care or that of a loved one,
为我们自己或自己爱的人
to help them with a decision.
做医疗决策。
And so I want to talk about that.
所以，我想谈谈这个话题。
And I'm going to talk about a very particular medical condition.
我要说一个非常特殊的医疗情况。
But this stands as a proxy for all kinds of medical decision-making,
但它代表了各种决策：医疗决策，
and indeed for financial decision-making, and social decision-making --
当然还有财政决策和社交决策——
any kind of decision you have to make
任何你必须做的决策，
that would benefit from a rational assessment of the facts.
可以让你从理性的事实评估中受益。
So suppose you go to your doctor and the doctor says,
假设你去看医生，而医生说，
"I just got your lab work back, your cholesterol's a little high."
“我刚拿到你验血结果， 你的胆固醇有点高。”
Now, you all know that high cholesterol
你们都知道，胆固醇高
is associated with an increased risk of cardiovascular disease,
会增加患心血管疾病，
heart attack, stroke.
心脏病和中风的风险。
And so you're thinking
所以，你会想
having high cholesterol isn't the best thing,
高胆固醇不是一件好事，
and so the doctor says, "You know, I'd like to give you a drug
那么医生会说：“我给你开点药，
that will help you lower your cholesterol, a statin."
帮助你降低胆固醇， 他汀类药就可以。”
And you've probably heard of statins,
你可能已经听说过他汀类药物，
you know that they're among the most widely prescribed drugs
现如今是医生开的
in the world today,
最多的处方药之一。
you probably even know people who take them.
你甚至可能认识服用这药的人。
And so you're thinking, "Yeah! Give me the statin."
于是你想，“好吧，给我他汀类药。”
But there's a question you should ask at this point,
但这个时候，你必须问一个问题，
a statistic you should ask for
一个许多医生不愿谈论，
that most doctors don't like talking about,
制药公司更不喜欢谈论到的
and pharmaceutical companies like talking about even less.
一个统计数字。
It's for the number needed to treat.
这个统计数字就是，治疗所需人数。
Now, what is this, the NNT?
这是什么意思呢， 治疗所需人数（NNT）？
It's the number of people that need to take a drug
它是指多少人服用了某种药，
or undergo a surgery or any medical procedure
或接收了手术或其他任何治疗方式，
before one person is helped.
才会有1人收益。
And you're thinking, what kind of crazy statistic is that?
你心说， 这是哪门子统计数字？
The number should be one.
这数字应该是1啊，
My doctor wouldn't prescribe something to me
如果这药对我没有帮助，
if it's not going to help.
那医生就不会开给我。
But actually, medical practice doesn't work that way.
但实际上， 医疗实践不是这样运行的。
And it's not the doctor's fault,
这不是医生的错，
if it's anybody's fault, it's the fault of scientists like me.
如果是某些人的错， 那就是像我一样的科学家的错。
We haven't figured out the underlying mechanisms well enough.
我们还没有想出足够好的运作机制。
But GlaxoSmithKline estimates
但据葛兰素史克制药公司 （Glaxo Smith Kline）估计，
that 90 percent of the drugs work in only 30 to 50 percent of the people.
90%的药品只对30%到50%的人有用。
So the number needed to treat for the most widely prescribed statin,
所以，这种最广泛的处方药的 治疗所需人数，
what do you suppose it is?
你们猜是多少？
How many people have to take it before one person is helped?
多少人要服用它 才会出现一个受益的人？
300.
300。
This is according to research
这是根据研究工作者 Jerome Groopman
by research practitioners Jerome Groopman and Pamela Hartzband,
和 Pamela Hartzband 做的研究得出的数据，
independently confirmed by Bloomberg.com.
这项研究由Bloomberg.com 权威网站独立证实过。
I ran through the numbers myself.
我自己想了一下这个数字。
300 people have to take the drug for a year
必须有300人服用此药一年，
before one heart attack, stroke or other adverse event is prevented.
才能预防一起心脏病， 中风或其他疾病。
Now you're probably thinking,
现在你可能在想，
"Well, OK, one in 300 chance of lowering my cholesterol.
“好吧，还有300分之1的机会 可以降低我的胆固醇。
Why not, doc? Give me the prescription anyway."
为什么不服用呢？医生， 给我开这个药。”
But you should ask at this point for another statistic,
但是你应该问医生， 有关这药的另一个统计数字，
and that is, "Tell me about the side effects." Right?
那就是，”告诉我这药的副作用。” 对吧？
So for this particular drug,
那么针对这种药，
the side effects occur in five percent of the patients.
副作用会发生在5%的患者身上。
And they include terrible things --
这些副作用包括一些可怕的情况——
debilitating muscle and joint pain, gastrointestinal distress --
肌无力，关节疼痛和肠胃不适 ——
but now you're thinking, "Five percent,
但你可能觉得：“ 才5%的比例，
not very likely it's going to happen to me,
不太可能发生在我身上，
I'll still take the drug."
我还是会服用它。”
But wait a minute.
但是，请等等。
Remember under stress you're not thinking clearly.
记住在压力下，你可能 思维混乱，不能考虑清楚。
So think about how you're going to work through this ahead of time,
所以，要提前思考一下你该如何做，
so you don't have to manufacture the chain of reasoning on the spot.
这样你就不用事到临头时 再去进行一连串的推理了。
300 people take the drug, right? One person's helped,
300人要服用这药， 才会有一个人受益，对吧？
five percent of those 300 have side effects,
300人中5%的人会 受药物副作用的影响，
that's 15 people.
也就是15人。
You're 15 times more likely to be harmed by the drug
你受药物副作用伤害的可能性
than you are to be helped by the drug.
是你受益于药物的15倍。
Now, I'm not saying whether you should take the statin or not.
我并不是想表明 你该不该服用他汀类药物。
I'm just saying you should have this conversation with your doctor.
我只是说，你应该咨询你的医生。
Medical ethics requires it,
医德要求我们这样做，
it's part of the principle of informed consent.
这是知情同意原则的一部分。
You have the right to have access to this kind of information
你有权力要求知道这类信息，
to begin the conversation about whether you want to take the risks or not.
有权和医生谈你是否 愿意承担这样的风险。
Now you might be thinking
现在你可能会想
I've pulled this number out of the air for shock value,
我为了制造震撼的效果 凭空捏造了这个数字，
but in fact it's rather typical, this number needed to treat.
但实际上，这个治疗所需人数 是相当具有代表性的。
For the most widely performed surgery on men over the age of 50,
对于50岁以上的男性， 做的最多的手术是为治疗
removal of the prostate for cancer,
前列腺癌而切除前列腺，
the number needed to treat is 49.
治疗所需人数是49。
That's right, 49 surgeries are done for every one person who's helped.
是的，49个患者做了手术 才会出现一个受益的人。
And the side effects in that case occur in 50 percent of the patients.
而这种情况手术的副作用 会发生在50%的患者身上。
They include impotence, erectile dysfunction,
这些副作用包括阳痿， 勃起功能障碍，
urinary incontinence, rectal tearing,
尿失禁，直肠撕裂，
fecal incontinence.
大便失禁。
And if you're lucky, and you're one of the 50 percent who has these,
如果你“有幸”成为了50% 受副作用影响的人中的一个，
they'll only last for a year or two.
这些副作用通常只会持续1-2年。
So the idea of the pre-mortem is to think ahead of time
所以，事前剖析是要提前想好
to the questions that you might be able to ask
你想问医生的问题，
that will push the conversation forward.
这样会深入推进你和医生的对话。
You don't want to have to manufacture all of this on the spot.
毕竟你不想事到临头 再来思考所有事情。
And you also want to think about things like quality of life.
而且你也需要考虑一下生活质量。
Because you have a choice oftentimes,
因为通常你是有选择的，
do you I want a shorter life that's pain-free,
你想要较短的没有痛苦的人生，
or a longer life that might have a great deal of pain towards the end?
或想要较长的最终 要承受巨大痛苦的人生呢？
These are things to talk about and think about now,
这些都是现在需要 谈论和思考的问题，
with your family and your loved ones.
和你的家人，爱人一起。
You might change your mind in the heat of the moment,
你可能会在事发时改变你的想法，
but at least you're practiced with this kind of thinking.
但至少你练习了这种思维方法。
Remember, our brain under stress releases cortisol,
请记住，我们的大脑 在压力下会释放皮质醇，
and one of the things that happens at that moment
在那一刻发生的一件事是
is a whole bunch on systems shut down.
你整个思维系统似乎停工了。
There's an evolutionary reason for this.
这里有一个进化方面的原因。
Face-to-face with a predator, you don't need your digestive system,
和一个捕食者面对面时， 你不需要你的消化系统，
or your libido, or your immune system,
性欲或者免疫系统的帮助。
because if you're body is expending metabolism on those things
因为如果你的身体忙着在 这些事情上进行新陈代谢，
and you don't react quickly,
你就不能迅速作出反应，
you might become the lion's lunch, and then none of those things matter.
那么你可能会成为狮子的午餐， 然后那些事情也就不重要了，
Unfortunately,
不幸的是，
one of the things that goes out the window during those times of stress
在紧张时，其中一件会出错的事情是
is rational, logical thinking,
理性地，有逻辑地思考。
as Danny Kahneman and his colleagues have shown.
Danny Kahneman和他的同事 已经证明了这点。
So we need to train ourselves to think ahead
所以，我们需要培养 自己超前思考的习惯，
to these kinds of situations.
去面对这类事情。
I think the important point here is recognizing that all of us are flawed.
这里很重要的一点是，要认识 到我们所有人都不是完美的。
We all are going to fail now and then.
我们都会不时地经历失败，
The idea is to think ahead to what those failures might be,
事前剖析就要超前思考 可能的失败会是什么，
to put systems in place that will help minimize the damage,
井然有序地做事有助于 把伤害减到最小，
or to prevent the bad things from happening in the first place.
或者在第一时间 防止糟糕的事情发生。
Getting back to that snowy night in Montreal,
说回到我在蒙特利尔 那个冰天雪地的晚上，
when I got back from my trip,
当我从欧洲返程回到家时，
I had my contractor install a combination lock next to the door,
我的承包商在门旁边安装了密码锁，
with a key to the front door in it, an easy to remember combination.
还有一把钥匙以及 一个简单易记的密码。
And I have to admit,
我不得不承认，
I still have piles of mail that haven't been sorted,
我还是有一堆没有分类的信件，
and piles of emails that I haven't gone through.
以及一堆没有处理的邮件。
So I'm not completely organized,
所以，我还没能完全做到井然有序，
but I see organization as a gradual process,
但我把井然有序做事 看成是一个渐进的过程，
and I'm getting there.
也正在慢慢实现这个目标。
Thank you very much.
谢谢。
(Applause)
（鼓掌）